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General NPI Number Information
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NPI Number | 1417009788
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Entity Type | Individual
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Provider Name | MARTIN ANTHONY RUSSELL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WRAMC BLDG DEPT OF PHARMACY 6900 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-6224
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Fax |
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Provider Business Mailing Address
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Address Line | 4808 DERUSSEY PKWY
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City | CHEVY CHASE
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State | MD
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Zip | 20815-5328
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Country | US
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Telephone | 202-256-5952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17407
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License Number State | MD
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